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Magalhães DDDD, Bandeira JDF, Costa BOID, Santos AS, Santos RV, da Silva HJ, Junior HVM, Pernambuco L. Hyoid Bone Movement During Swallowing in Female Thyroidectomy Patients: A Kinematic Ultrasound Study. Dysphagia 2024; 39:956-963. [PMID: 38436670 DOI: 10.1007/s00455-024-10676-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/23/2024] [Indexed: 03/05/2024]
Abstract
The aim of this study was to investigate the measures of displacement, time and velocity of hyoid bone movement in female thyroidectomy patients. Fifty-eight ultrasound videos of 29 women during swallowing were analyzed. The sample was divided into experimental group (EG), composed of 12 women following total or partial thyroidectomy; and control group (CG) of 17 healthy women. The kinematic measures of displacement, time and velocity of hyoid bone displacement were tracked during swallowing of 10 ml of liquid (water) and 10 ml of thickened liquid (honey) in both groups for comparisons. Additional analysis included bolus consistency effect and relationship with clinical characteristics. Ultrasound videos were analyzed according to a standardized protocol using ImageJ software. Displacement, time and velocity of hyoid movement during swallowing of 10 ml of liquid or thickened liquid were not statistically different between female thyroidectomy patients and healthy women. There is no bolus consistency effect on kinematic measures in both groups, but among thyroidectomy patients, velocity of hyoid bone movement is significantly faster in those with swallowing complaints.
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Affiliation(s)
- Desiré Dominique Diniz de Magalhães
- Graduate Program in Speech, Language and Hearing Sciences (PPgFon-UFPB), Universidade Federal da Paraíba (UFPB), Campus I s/n, Cidade Universitária, João Pessoa, PB, 58051-900, Brazil
| | - Jayne de Freitas Bandeira
- Graduate Program in Speech, Language and Hearing Sciences (PPgFon-UFPB), Universidade Federal da Paraíba (UFPB), Campus I s/n, Cidade Universitária, João Pessoa, PB, 58051-900, Brazil
| | - Bianca Oliveira Ismael da Costa
- Graduate Program in Speech, Language and Hearing Sciences (PPgFon-UFPB), Universidade Federal da Paraíba (UFPB), Campus I s/n, Cidade Universitária, João Pessoa, PB, 58051-900, Brazil
| | - Ary Serrano Santos
- Lauro Wanderley University Hospital (HULW/EBSERH), Universidade Federal da Paraíba (UFPB), R. Tabelião Stanislau Eloy, 585, Castelo Branco, João Pessoa, PB, 58050-585, Brazil
| | - Ricardo Vieira Santos
- Lauro Wanderley University Hospital (HULW/EBSERH), Universidade Federal da Paraíba (UFPB), R. Tabelião Stanislau Eloy, 585, Castelo Branco, João Pessoa, PB, 58050-585, Brazil
| | - Hilton Justino da Silva
- Department of Speech, Language and Hearing Sciences, Universidade Federal de Pernambuco (UFPE), Cidade Universitária, Recife, PE, 50670901, Brasil
| | - Hipólito Virgílio Magalhães Junior
- Department of Speech, Language and Hearing Sciences, Universidade Federal do Rio Grande do Norte (UFRN), Rua General Gustavo Cordeiro de Farias s/n, Petrópolis, Natal, RN, 59012-570, Brazil
| | - Leandro Pernambuco
- Graduate Program in Speech, Language and Hearing Sciences (PPgFon-UFPB), Universidade Federal da Paraíba (UFPB), Campus I s/n, Cidade Universitária, João Pessoa, PB, 58051-900, Brazil.
- Department of Speech, Language and Hearing Sciences, Universidade Federal de Pernambuco (UFPE), Cidade Universitária, Recife, PE, 50670901, Brasil.
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Bandeira JDF, Magalhães DDDD, Pernambuco L. Variability in quantitative outcomes of instrumental swallowing assessments in adults: a scoping review. Codas 2024; 36:e20240046. [PMID: 39292020 PMCID: PMC11404840 DOI: 10.1590/2317-1782/20242024046pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/02/2024] [Indexed: 09/19/2024] Open
Abstract
PURPOSE To map scientific evidence on the variability of quantitative parameters extracted by instrumental swallowing assessment tests in adults, using the coefficient of variation. RESEARCH STRATEGIES The methodological procedures recommended by the Joanna Briggs Institute and the extension for scoping reviews of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA-ScR) were followed. SELECTION CRITERIA The search was carried out in the Pubmed/Medline, Lilacs, Cochrane Library, Embase, Web of Science, Scopus and CINAHL databases, as well as in Google Scholar to consult the gray literature. DATA ANALYSIS Two blind and independent reviewers screened the articles by title and abstract. Subsequently, the articles were read in full and selected according to the eligibility criteria. Data were extracted according to a standardized instrument. RESULTS 363 studies were found, 13 of which were eligible. Most studies had a sample size of less than 30 participants and were made up of healthy individuals. The instrumental exams used were diverse: videofluoroscopy, electrical impedance tomography, laryngeal sensors, high-resolution manometry and surface electromyography. The studies searched for intra-individual variability and the coefficient of variation ranged from low to high variability, as the instruments, parameters and collection procedures were very heterogeneous and non-standardized. CONCLUSION Intra-individual variability of the quantitative outcomes of instrumental swallowing assessments in adults ranged from low to high according to the exam, outcome, presence or absence of underlying disease, consistency and volume of the bolus.
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Freedman-Doan A, Pereyra Maldonado L, Lowell SY. Hyolaryngeal Kinematics in Primary Muscle Tension Dysphonia Determined by Ultrasound. J Voice 2024:S0892-1997(24)00264-9. [PMID: 39232880 DOI: 10.1016/j.jvoice.2024.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 08/13/2024] [Accepted: 08/14/2024] [Indexed: 09/06/2024]
Abstract
OBJECTIVES The purpose of this study was to determine hyolaryngeal kinematics during voicing in people with primary muscle tension dysphonia (pMTD) compared with healthy speakers, and to investigate the relationships between hyolaryngeal displacement and self-perceived vocal function. METHODS Twenty-six participants, 13 with pMTD and 13 healthy speakers, were assessed using sonography during sustained vowel phonation and rest. Displacement of the hyoid bone and thyroid cartilage was measured from still frames extracted from ultrasound video recordings, with measures normalized to reflect change from rest during voicing for each participant. Vocal function was determined for all participants through self-perceived speaking effort and the Voice Handicap Index-10. RESULTS Normalized displacement of the hyoid bone and thyroid cartilage was significantly greater during voicing for participants with pMTD than for the healthy speakers. Weak-to-moderate, nonsignificant relationships between hyoid displacement and vocal function measures were evidenced, whereas moderate-to-strong, significant relationships were found for thyroid displacement and vocal function measures. CONCLUSIONS Displacement of the hyoid and elevation of the larynx during phonation appear to be prominent features of pMTD that differentiate the disorder from healthy phonatory kinematics. Ultrasound imaging provides a sensitive, reliable, noninvasive, and feasible method for objectively determining hyolaryngeal kinematics and may be useful for differential diagnosis and determination of treatment outcomes in pMTD.
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Affiliation(s)
- Anya Freedman-Doan
- Department of Communication Sciences and Disorders, Syracuse University, Syracuse, New York
| | | | - Soren Y Lowell
- Department of Communication Sciences and Disorders, Syracuse University, Syracuse, New York.
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Bragato SGR, da Silva RG, Berti LC. Ultrasonographic analysis of the hyoid bone distance in individuals with neurogenic oropharyngeal dysphagia. Codas 2024; 36:e20220074. [PMID: 38836820 PMCID: PMC11166034 DOI: 10.1590/2317-1782/20242022074pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 10/11/2023] [Indexed: 06/06/2024] Open
Abstract
To compare the ultrasound measurement of distance from the approximation of the hyoid bone during of the maximum deglutition peak between healthy individuals and neurogenic dysphagic individuals and to verify the effect of food consistencies on the displacement of the hyoid bone. Prospective, controlled clinical study. Ultrasound recordings of the oropharyngeal deglutition were conducted in 10 adults diagnosed with oropharyngeal dysphagia and in 10 healthy adults, matched by sex and age group. A portable ultrasound model Micro ultrasound system with a microconvex transducer 5-10 MHz, coupled to a computer as well as the head stabilizer were used. The ultrasound images were recorded using the AAA software (Articulate Assistant Advanced) at a rate of 120 frames/second. Food consistencies level 0 (free volume and 5 mL) and level 4 (5 mL) were used, based on the International Dysphagia Diet Standardisation Initiative (IDSSI). The calculation of the mean and standard deviation was used for the descriptive analysis, while the repeated measures ANOVA test was used for the inferential analysis. Results showed dysphagic individuals had lower elevation of the hyoid bone marked by a longer distance from the approximation of the hyoid bone during of the maximum deglutition peak when compared to healthy individuals, regardless of the food consistency offered. It was concluded that the ultrasound measurement of distance from the approximation of the hyoid bone during of the maximum deglutition peak showed less laryngeal elevation in individuals with neurogenic oropharyngeal dysphagia when compared to healthy individuals for all food consistencies offered.
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Affiliation(s)
- Simone Galli Rocha Bragato
- Programa de Pós-graduação em Fonoaudiologia, Universidade Estadual Paulista – UNESP - Marília (SP), Brasil.
| | - Roberta Gonçalves da Silva
- Laboratório de Pesquisa e Reabilitação em Disfagia, Departamento de Fonoaudiologia, Universidade Estadual Paulista – UNESP - Marília (SP), Brasil.
| | - Larissa Cristina Berti
- Laboratório de Análise Articulatória e Acústica, Departamento de Fonoaudiologia, Universidade Estadual Paulista – UNESP - Marília (SP), Brasil.
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de Andrade RA, Pernambuco LDA, de Almeida ANS, Mulatinho MEDCP, Dos Santos ENF, da Silva HJ. Methodological Procedures to Acquire and Analyze Ultrasound Images of Swallowing: A Scoping Review. Dysphagia 2024:10.1007/s00455-024-10714-1. [PMID: 38802587 DOI: 10.1007/s00455-024-10714-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/19/2024] [Indexed: 05/29/2024]
Abstract
This scoping review aimed to identify methodological procedures for acquiring and analyzing ultrasound images related to swallowing in adults and older adults. The inclusion criteria were based on the PCC strategy (participants, concept, and context), as follows: population (adults and older adults), concept (ultrasound assessment), and context (swallowing assessment). The review included observational, experimental, descriptive, and analytical studies and excluded those that were not available in full, animal studies, in vitro studies, letters to the editor, errata, study protocols, and those that used ultrasound for purposes other than swallowing. There were no language and time restrictions. Two independent blinded professionals selected 81 articles that met the inclusion criteria from different databases. The most evaluated parameters included tongue morphology and movements, hyoid bone displacement, swallowing muscle area, and pharyngeal residue detection, such as pharyngeal wall mobility. They used convex and linear transducers (3 MHz to 8 MHz) positioned in the submental, laryngeal, and lateral regions of the neck. The subjects were seated and instructed to eat different food volumes and consistencies. The literature mapping showed that ultrasound is a promising diagnostic tool, helping clinicians understand swallowing disorders, as it provides static and dynamic images in different modes and positions. Also, patients receive real-time biofeedback of changes related to dysphagia.
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Affiliation(s)
- Rodrigo Alves de Andrade
- Department of Speech-Language-Hearing Sciences, Federal University of Pernambuco, Av. Prof. Artur de Sá, S/N - Cidade Universitária, Recife, PE, CEP 50674-420, Brazil.
| | - Leandro de Araújo Pernambuco
- Federal University of Pernambuco, UFPE, Av. Prof. Artur de Sá, S/N - Cidade Universitária, Recife, PE, CEP 50674-420, Brazil
| | | | | | | | - Hilton Justino da Silva
- Federal University of Pernambuco, UFPE, Av. Prof. Artur de Sá, S/N - Cidade Universitária, Recife, PE, CEP 50674-420, Brazil
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Pauloski BR, Yahnke KM. Reliability of Measuring Geniohyoid Cross-Sectional Area with B-Mode Ultrasound. Dysphagia 2024:10.1007/s00455-024-10712-3. [PMID: 38789680 DOI: 10.1007/s00455-024-10712-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 04/19/2024] [Indexed: 05/26/2024]
Abstract
B-mode ultrasound is a safe noninvasive procedure that has been used to characterize aspects of the oropharyngeal swallow. The submental suprahyoid muscles are often investigated with ultrasound because of their contributions to hyolaryngeal elevation. There are several techniques for positioning the ultrasound transducer in the coronal plane, however, there is limited research on how reliability of measurement of the cross-sectional area (CSA) of the geniohyoid differs across transducer placement technique. This study examined three methods of transducer placement in the coronal plane by two examiners to determine the reliability of measurement of CSA of the geniohyoid muscle. Forty healthy adults participated in the study. Each participant's geniohyoid muscles were imaged using B-mode ultrasound under three transducer placement conditions in the coronal plane by two examiners. Geniohyoid CSA was measured from each ultrasound image. A three-way mixed-methods ANOVA was used to determine whether there were significant differences in geniohyoid CSA among transducer position conditions, trials, and examiners. There were significant differences among the transducer placement conditions, indicating that each condition was measuring a different portion of the muscle. There were no significant differences among repeated trials nor between examiners within each method of transducer placement. All three conditions of transducer placement were reliable at measuring geniohyoid CSA across trials and examiners. This study emphasizes the need for consistency of placement, whichever method is selected. It also highlights the need for researchers to provide a precise description of methods for positioning the transducer so that placement is reproducible.
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Affiliation(s)
- Barbara R Pauloski
- Department of Communication Sciences and Disorders, College of Health Sciences, University of Wisconsin Milwaukee, 2400 E. Hartford Avenue, Suite 840, Milwaukee, WI, 53211, USA.
| | - Kacey M Yahnke
- Department of Communication Sciences and Disorders, College of Health Sciences, University of Wisconsin Milwaukee, 2400 E. Hartford Avenue, Suite 840, Milwaukee, WI, 53211, USA
- Manhattan Star Academy, 180 Amsterdam Avenue, New York, NY, 10023, USA
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Barron K, Blaivas M, Blaivas L, Sadler J, Deal I. Bedside Ultrasound to Identify and Predict Severity of Dysphagia Following Ischemic Stroke: Human Versus Artificial Intelligence. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:99-104. [PMID: 37858370 DOI: 10.1016/j.ultrasmedbio.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/27/2023] [Accepted: 09/11/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE Dysphagia is a significant ischemic stroke complication that can lead to aspiration. Identification of at-risk patients can be logistically difficult and costly. Researchers investigated whether quantitative ultrasound assessment of hyoid bone movement during induced swallowing would predict failure of videofluoroscopy (VFS) or fiberoptic endoscopic evaluation of swallowing (FEES), as determined by a penetration-aspiration scale (PAS) score. Additionally, ability of a machine learning (ML) algorithm to predict PAS success or failure from real-time ultrasound video recordings was assessed. METHODS A prospective, single-blinded, observational pilot study was conducted from June 2019 through March 2020 at a comprehensive stroke center on a convenience sample of patients admitted with diagnosis of acute ischemic stroke undergoing VFS or FEES as part of dysphagia assessment. Researchers performed a midsagittal airway ultrasound during swallowing in patients receiving an objective swallowing assessment by speech language pathologists who were blinded to ultrasound results. Sonologists measured hyoid bone movement, and researchers then constructed an ML algorithm designed for real-time video analysis using a long short-term memory network with an embedded VGG16 convolutional neural network. RESULTS Videos from 69 patients were obtained with their respective PAS results. In total, 90% of available videos were used for algorithm training. After training, the ML algorithm was challenged with the 10% previously unseen videos and then compared with PAS outcomes. Statistical analysis included logistic regression and correlation matrix testing on human ultrasound measurements. Cohen's κ was calculated to compare deep learning algorithm prediction with PAS results. Measurement of hyoid bone elevation, forward displacement, total displacement and mandible length was unable to predict PAS assessment outcome (p values = 0.36, 0.13, 0.11 and 0.32, respectively). The ML algorithm showed substantial agreement with PAS testing results for predicting test outcome (κ = 0.79; 95% confidence interval: 0.52-1.0) CONCLUSION: Manual ultrasound measurement of hyoid movement during swallowing in stroke patients failed to predict PAS swallowing results. However, an ML algorithm showed substantial agreement with PAS results despite a small data set, which could greatly improve access to dysphagia assessment in the future.
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Affiliation(s)
- Keith Barron
- Prisma Health Midlands/Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, SC, USA.
| | - Michael Blaivas
- Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, SC, USA
| | - Laura Blaivas
- Department of Internal Medicine, Michigan State University, East Lansing, MI, USA
| | - John Sadler
- Department of Medicine, VCU Health, Richmond, VA, USA
| | - Isadora Deal
- University of South Carolina School of Medicine, Columbia, SC, USA
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Parekh MH, Thuler E, Triantafillou V, Seay E, Sehgal C, Schultz S, Keenan BT, Schwartz AR, Dedhia RC. The Application of Ultrasound to Quantify Hyoid Motion During Drug-Induced Sleep Endoscopy. Laryngoscope 2023; 133:3221-3227. [PMID: 37283467 PMCID: PMC10592545 DOI: 10.1002/lary.30805] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/18/2023] [Accepted: 05/24/2023] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The significance of hyoid dynamics in OSA pathophysiology remains unclear. Drug-induced sleep endoscopy (DISE) is often used for evaluating patients intolerant to positive airway pressure (PAP) therapy. We performed DISE with concurrent hyoid-focused ultrasonography to quantify hyoid dynamics during obstructive and non-obstructive breathing. METHODS A cross-sectional analysis from a prospective cohort of patients undergoing DISE with PAP titration (DISE-PAP) and hyoid-focused ultrasound was conducted. Hyoid ultrasound was performed during obstructive breathing, and non-obstructive breathing after PAP administration. Motion was quantified by generating displacement curves based on echo-tracking hyoid movement. The image analysis protocol for quantifying hyoid displacement was performed independently by two researchers, and reliability of measures was assessed. Univariate and multivariate regressions were performed for various clinical data and hyoid displacement during obstructive breathing. RESULTS Twenty patients met inclusion criteria. On average, the cohort was male (75%), elderly (65.9 ± 10 years), overweight (29.3 ± 3.99 kg/m2 ), and with moderate-to-severe OSA (29.3 ± 12.5 events/h). Mean hyoid displacement during obstructive breathing was 5.81 mm (±3.48). In all patients, hyoid displacement decreased after PAP administration (-3.94 mm [95% CI: -5.10, -2.78]; p < 0.0001). Inter-rater reliability for measures of hyoid displacement was excellent. After multivariate regression, hyoid displacement at baseline was associated with higher AHI (β [95% CI] = 0.18 [0.03, 0.33], p = 0.020). CONCLUSION During DISE, hyoid displacement is greater during obstructive breathing with significant variability amongst patients. Further, these ultrasonographic measurements had excellent intra- and inter-rater reliability. Additional, larger studies are needed to understand contributors to hyoid mobility. LEVEL OF EVIDENCE 4 Laryngoscope, 133:3221-3227, 2023.
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Affiliation(s)
- Manan H. Parekh
- Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania
| | - Eric Thuler
- Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania
| | | | - Everett Seay
- Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania
| | | | | | - Brendan T. Keenan
- Division of Sleep Medicine/Department of Medicine, University of Pennsylvania
| | - Alan R. Schwartz
- Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania
| | - Raj C. Dedhia
- Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania
- Division of Sleep Medicine/Department of Medicine, University of Pennsylvania
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Rodrigues R, Sassi FC, Silva APD, Andrade CRFD. Correlation between findings of the oral myofunctional clinical assessment, pressure and electromyographic activity of the tongue during swallowing in individuals with different orofacial myofunctional disorders. Codas 2023; 35:e20220053. [PMID: 37820097 DOI: 10.1590/2317-1782/20232022053pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 10/10/2022] [Indexed: 10/13/2023] Open
Abstract
PURPOSE To correlate the findings regarding the myofunctional orofacial examination, tongue pressure and surface electromyography (sEMG) of deglutition in individuals with different orofacial myofunctional disorders. METHODS 44 patients (20 males and 24 females, aged between 17 and 63 years old) with different orofacial myofunctional changes were clinically assessed using the Expanded Protocol of Orofacial Myofunctional Evaluation with Scores (OMES-E). In addition, the range of mandibular movements and facial anthropometry were measured, along with the assessment of the tongue pressure (tip and dorsum) and of the electrical activity of the suprahyoid muscles during deglutition, using surface electromyography (sEMG). RESULTS The statistical analysis found weak correlations between tongue dorsum pressure values, suggesting that the greater the measurement of the lower third of the face, the lower the pressure of the tongue dorsum; the greater the measurement of the overlaps (vertical and horizontal), the higher the pressure of the tongue dorsum; the higher the score from the orofacial evaluation and orofacial functions assessment, the higher the pressure of the tongue dorsum; and the higher the pressure of the tongue dorsum, the higher the pressure of the tongue tip. CONCLUSION The present study results indicate that the orofacial myofunctional changes found in different groups of patients are more related to the maxillomandibular discrepancies than to the pathologies investigated herein.
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Affiliation(s)
- Robson Rodrigues
- Divisão de Fonoaudiologia, Hospital das Clínicas - HC, Faculdade de Medicina - FM, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Fernanda Chiarion Sassi
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina - FM, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Amanda Pagliotto da Silva
- Divisão de Fonoaudiologia, Hospital das Clínicas - HC, Faculdade de Medicina - FM, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Claudia Regina Furquim de Andrade
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina - FM, Universidade de São Paulo - USP - São Paulo (SP), Brasil
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Bahia MM, Lowell SY. Hyolaryngeal Movement During Normal and Effortful Swallows Determined During Ultrasonography. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:3856-3870. [PMID: 37668547 DOI: 10.1044/2023_jslhr-23-00088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
PURPOSE This study investigated (a) the effects of the effortful swallow under two different instructions (tongue emphasis vs. pharyngeal squeezing) on hyoid displacement and hyoid-larynx approximation, (b) the association between tongue pressure and hyolaryngeal movement during normal swallowing and the effortful swallow produced with tongue emphasis, and (c) age-related differences in hyolaryngeal movement during normal and effortful swallows (tongue emphasis vs. pharyngeal squeezing) in healthy individuals. METHOD Forty healthy adults (20 younger and 20 older) swallowed their saliva as they normally do (normal swallow) and performed the effortful swallow with tongue emphasis and pharyngeal squeezing. Tongue-to-palate pressure during swallowing was measured using the Iowa Oral Performance Instrument, hyolaryngeal movement was measured using ultrasonography, and submental surface electromyography was used to track swallows. RESULTS Results revealed differences in hyolaryngeal movement across swallowing types. Both types of effortful swallows showed greater hyolaryngeal movement than normal swallows. Additionally, hyolaryngeal movement was greater during the effortful swallow with tongue emphasis than the effortful swallow with pharyngeal squeezing. Age-related differences were found only in hyoid-larynx approximation during the effortful swallow with tongue emphasis (younger > older adults). Furthermore, moderate positive correlations were identified between tongue pressure and hyolaryngeal movement during normal swallows and the effortful swallow with tongue emphasis. CONCLUSIONS The findings show that varying instructions of the effortful swallow affect hyolaryngeal movement differently, suggesting that clinicians may need to individualize the effortful swallow instruction according to the physiological impairments of each patient. Additionally, natural age-related changes in swallowing physiology do not seem to affect an individual's ability to perform the effortful swallow or to impact hyolaryngeal movement. Finally, the association between tongue pressure and hyolaryngeal movement during normal swallows and the effortful swallow with tongue emphasis suggests that the tongue plays a critical role in swallowing, priming subsequent swallowing events.
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Affiliation(s)
- Mariana M Bahia
- Department of Communication Sciences and Disorders, Syracuse University, NY
| | - Soren Y Lowell
- Department of Communication Sciences and Disorders, Syracuse University, NY
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Liao LJ, Tung YH, Lin YH, Hsu WL. Application of Real-time Submental Ultrasonography to Assess Swallowing. J Med Ultrasound 2023; 31:287-292. [PMID: 38264601 PMCID: PMC10802867 DOI: 10.4103/jmu.jmu_110_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/05/2022] [Accepted: 12/16/2022] [Indexed: 01/25/2024] Open
Abstract
Background Speech and swallowing dysfunction are common problems in head-and-neck cancer (HNC) survivors. Ultrasound (US) is a good method to assess suprahyoid muscles and hyoid bone movement, and it can provide valuable information on swallowing. The aims of this study were to measure the biometry of the supraglottic muscles and hyoid bone movement during swallowing and elucidate the application of real-time US for assessing swallowing dysfunction. Methods We collected data from HNC and thyroid cancer patients with dysphagia symptoms and healthy controls without a history of cancer or dysphagia symptoms for comparison. Real-time submental US was used to check the anterior belly of the digastric muscle, geniohyoid (GH) muscles, and hyoid bone movement during swallowing. Logistic regression analysis was used to explore significant US predictors of dysphagia. Based on the regression coefficients of independent variables, we established the nomogram prediction model for dysphagia. Results There were significant differences in GH size at contraction, GH size increase percentage, GH length at rest, GH length increase percentage, anterior displacement of the hyoid bone and superior displacement of the hyoid bone between the cancer survivors with dysphagia and volunteers without dysphagia. In multivariate logistic analysis, after adjusting for sex and age, the proportion of GH length contraction <22% (odds ratio [OR]: 6.8 95% confidence interval [CI]: 1.1-42.6) and hyoid bone superior displacement <3.3 mm (OR: 10.7, 1.8-64.1) were associated with a higher risk of dysphagia (P < 0.05). Conclusion We confirmed that GH muscle and hyoid bone movement are important for normal swallowing function. US is a good method to assess the suprahyoid muscles and hyoid bone movement, which could provide valuable information on swallowing.
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Affiliation(s)
- Li-Jen Liao
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan
- Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei, Taiwan
- Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan
| | - Yung-Hsin Tung
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Hsuan Lin
- Master Program of Big Data Analysis in Biomedicine, Fu-Jen Catholic University, New Taipei, Taiwan
| | - Wan-Lun Hsu
- Master Program of Big Data Analysis in Biomedicine, Fu-Jen Catholic University, New Taipei, Taiwan
- Data Science Center, College of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan
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Maeda K, Nagasaka M, Nagano A, Nagami S, Hashimoto K, Kamiya M, Masuda Y, Ozaki K, Kawamura K. Ultrasonography for Eating and Swallowing Assessment: A Narrative Review of Integrated Insights for Noninvasive Clinical Practice. Nutrients 2023; 15:3560. [PMID: 37630750 PMCID: PMC10460049 DOI: 10.3390/nu15163560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/28/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
Dysphagia is a syndrome of abnormal eating function resulting from a variety of causative diseases, and is associated with malnutrition. To date, the swallowing function has been difficult to examine without the use of invasive and expensive methods, such as the videofluorographic swallowing study or fiberoptic endoscopic evaluation of swallowing. In recent years, progress has been made in the clinical application of ultrasound equipment for the evaluation of body compositions near the body surface, including the assessment of nutritional status. Ultrasound examination is a noninvasive procedure and relatively inexpensive, and the equipment required is highly portable thanks to innovations such as wireless probes and tablet monitoring devices. The process of using ultrasound to visualize the geniohyoid muscle, digastric muscle, mylohyoid muscle, hyoid bone, tongue, masseter muscle, genioglossus muscle, orbicularis oris muscle, temporalis muscle, pharynx, esophagus, and larynx, and the methods used for evaluating these structures, are provided in this study in detail. This study also aims to propose a protocol for the assessment of swallowing-related muscles that can be applied in real-world clinical practice for the diagnosis of sarcopenic dysphagia, which can occur in elderly patients with sarcopenia, and has received much attention in recent years.
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Affiliation(s)
- Keisuke Maeda
- Nutrition Therapy Support Center, Aichi Medical University Hospital, Nagakute 480-1195, Japan
- Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan
| | - Motoomi Nagasaka
- Department of Rehabilitation Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.N.); (K.H.); (M.K.); (Y.M.); (K.O.); (K.K.)
| | - Ayano Nagano
- Department of Nursing, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya 663-8211, Japan;
| | - Shinsuke Nagami
- Department of Speech Language Pathology and Audiology, Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Okayama 701-0193, Japan;
| | - Kakeru Hashimoto
- Department of Rehabilitation Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.N.); (K.H.); (M.K.); (Y.M.); (K.O.); (K.K.)
| | - Masaki Kamiya
- Department of Rehabilitation Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.N.); (K.H.); (M.K.); (Y.M.); (K.O.); (K.K.)
| | - Yuto Masuda
- Department of Rehabilitation Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.N.); (K.H.); (M.K.); (Y.M.); (K.O.); (K.K.)
| | - Kenichi Ozaki
- Department of Rehabilitation Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.N.); (K.H.); (M.K.); (Y.M.); (K.O.); (K.K.)
| | - Koki Kawamura
- Department of Rehabilitation Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.N.); (K.H.); (M.K.); (Y.M.); (K.O.); (K.K.)
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de Magalhães DDD, Bandeira JDF, Pernambuco L. Quantitative approach to analyze hyoid bone movement during swallowing by ultrasound: an integrative review. Codas 2023; 35:e20220002. [PMID: 37466503 PMCID: PMC10446754 DOI: 10.1590/2317-1782/20232022002pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 07/01/2022] [Indexed: 07/20/2023] Open
Abstract
PURPOSE To synthesize the scientific knowledge on which measurements of hyoid bone movement during swallowing are obtained by ultrasonography and how to extract these measures. RESEARCH STRATEGIES The PECO question and combinations of descriptors and keywords were formulated in the electronic databases Medline/PubMed, EMBASE, Web of Science, Scopus and Lilacs. SELECTION CRITERIA Articles that used ultrasonography to analyze measurements of hyoid bone movement during swallowing were included, regardless of language, year of publication, or presence of deglutition disorders. DATA ANALYSIS The included articles were analyzed for: year, study site, study design, population, sample size, equipment used, transducer positioning, measurements obtained, method of extraction, and reliability of measurements. RESULTS Twenty-six articles met the eligibility criteria. The most frequent measurement was hyoid movement maximum amplitude, followed by time and velocity. There was great variability in the study population, equipment used, positioning of the transducer and method of extraction of the measurements. Thus, it was not possible to find a standard model to extract the measures. The level of reliability was investigated in only eight articles. CONCLUSION Amplitude, time and velocity are the measures of hyoid bone movement during swallowing that can be obtained by ultrasonography. There is no standardization on how to extract these measurements.
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Affiliation(s)
| | - Jayne de Freitas Bandeira
- Programa Associado de Pós-graduação em Fonoaudiologia, Universidade Federal da Paraíba - UFPB - João Pessoa (PB), Brasil.
| | - Leandro Pernambuco
- Programa Associado de Pós-graduação em Fonoaudiologia, Universidade Federal da Paraíba - UFPB - João Pessoa (PB), Brasil.
- Departamento de Fonoaudiologia, Universidade Federal da Paraíba - UFPB - João Pessoa (PB), Brasil.
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Andrade RAD, do Sales Coriolano MDGW, de Souza ELH, da Silva JHC, da Cunha MD, Pernambuco L, Ribeiro VV, da Silva HJ. Reliability of Ultrasound Examination of Hyoid Bone Displacement Amplitude: A Systematic Review and Meta-Analysis. Dysphagia 2022; 37:1375-1385. [PMID: 35230536 DOI: 10.1007/s00455-022-10429-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/14/2022] [Indexed: 12/16/2022]
Abstract
In swallowing, the hyoid bone moves up and forward in response to the activation of suprahyoid muscles, opening the upper esophageal sphincter and aiding the airway protection mechanism. This displacement measure has been analyzed with ultrasound images because this method does not expose the patient to radiation, has a good cost-benefit ratio, and is safe for the patient. However, there is no consensus on the reliability of this ultrasound measure. The objective of this study was to analyze the reliability of measuring hyoid bone displacement amplitude in swallowing with ultrasound. The systematic review encompassed five databases (MEDLINE, Scopus, EMBASE, Web of Science, Cochrane Library) and gray literature. There was no limitation of language or year of publication. The search/selection/extraction methodology was conducted by two authors blindly and independently, and differences were solved by a third rater. Three studies met the eligibility criteria: two of them analyzed the reliability in non-dysphagic populations and the other, in dysphagic patients. The transducer was positioned in the submandibular region in all studies. The authors were not clear about the training time to acquire and analyze ultrasound images. The meta-analysis had an interrater reliability of 0.858 (95% CI: 0.744-0.924) and intrarater reliability of 0.968 (95% CI: 0.903-0.990). There was, however, heterogeneity of p = 0.005 for intrarater reliability. Despite good reliability, the heterogeneity reinforces the importance of training and protocol standardization for image acquisition and analysis.
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Affiliation(s)
- Rodrigo Alves de Andrade
- Federal University of Pernambuco, UFPE. Recife, Teacher Artur de Sá Street, S/N, University City, Recife, PE, 50674-420, Brazil.
| | | | - Eduarda Lopes Honorato de Souza
- Federal University of Pernambuco, UFPE. Recife, Teacher Artur de Sá Street, S/N, University City, Recife, PE, 50674-420, Brazil
| | - Jamilly Henrique Costa da Silva
- Federal University of Pernambuco, UFPE. Recife, Teacher Artur de Sá Street, S/N, University City, Recife, PE, 50674-420, Brazil
| | - Maria Deluana da Cunha
- Federal University of Pernambuco, UFPE. Recife, Teacher Artur de Sá Street, S/N, University City, Recife, PE, 50674-420, Brazil
| | - Leandro Pernambuco
- Federal University of Paraíba, UFPB, Campus I, Lot. University City, João Pessoa, PB, 58051-900, Brazil
| | - Vanessa Veis Ribeiro
- University of Brasília - UnB, University Campus Darcy Ribeiro, S/N - Asa Norte, Brasília, DF, 70910-900, Brazil
| | - Hilton Justino da Silva
- Federal University of Pernambuco, UFPE. Recife, Teacher Artur de Sá Street, S/N, University City, Recife, PE, 50674-420, Brazil
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Ultrasonography as Biofeedback to Increase Muscle Activation During the Mendelsohn Maneuver in Healthy Adults. Dysphagia 2022:10.1007/s00455-022-10542-1. [DOI: 10.1007/s00455-022-10542-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/14/2022] [Indexed: 11/25/2022]
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Ma JK, Wrench AA. Automated assessment of hyoid movement during normal swallow using ultrasound. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:615-629. [PMID: 35285113 PMCID: PMC9314830 DOI: 10.1111/1460-6984.12712] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 02/10/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND The potential for using ultrasound by speech and language therapists (SLTs) as an adjunct clinical tool to assess swallowing function has received increased attention during the COVID-19 pandemic, with a recent review highlighting the need for further research on normative data, objective measurement, elicitation protocol and training. The dynamic movement of the hyoid, visible in ultrasound, is crucial in facilitating bolus transition and protection of the airway during a swallow and has shown promise as a biomarker of swallowing function. AIMS To examine the kinematics of the hyoid during a swallow using ultrasound imaging and to relate the patterns to the different stages of a normal swallow. To evaluate the accuracy and robustness of two different automatic hyoid tracking methods relative to manual hyoid position estimation. METHODS & PROCEDURES Ultrasound data recorded from 15 healthy participants swallowing a 10 ml water bolus delivered by cup or spoon were analysed. The movement of the hyoid was tracked using manually marked frame-to-frame positions, automated hyoid shadow tracking and deep neural net (DNN) tracking. Hyoid displacement along the horizontal image axis (HxD) was charted throughout a swallow, and the maximum horizontal displacement (HxD max) and maximum hyoid velocity (HxV max) along the same axis were automatically calculated. OUTCOMES & RESULTS The HxD and HxV of 10 ml swallows are similar to values reported in the literature. The trajectory of the hyoid movement and its location at significant swallow event time points showed increased hyoid displacement towards the peak of the swallow. Using an interclass correlation coefficient, HxD max and HxV max values derived from the DNN tracker and shadow tracker are shown to be in high agreement and moderate agreement, respectively, when compared with values derived from manual tracking. CONCLUSIONS & IMPLICATIONS The similarity of the hyoid tracking results using ultrasound to previous reports based on different instrumental tools supports the possibility of using hyoid movement as a measure of swallowing function in ultrasound. The use of machine learning to automatically track the hyoid movement potentially provides a reliable and efficient way to quantify swallowing function. These findings contribute towards improving the clinical utility of ultrasound as a swallowing assessment tool. Further research on both normative and clinical populations is needed to validate hyoid movement metrics as a means of differentiating normal and abnormal swallows and to verify the reliability of automatic tracking. WHAT THIS PAPER ADDS What is already known on this subject There is growing interest in the use of ultrasound as an adjunct tool for assessing swallowing function. However, there is currently insufficient knowledge about the patterning and timing of lingual and hyoid movement in a typical swallow. We know that movement of the hyoid plays an essential role in bolus transition and airway protection. However, manual tracking of hyoid movement is time-consuming and restricts the extent of large-scale normative studies. What this study adds We show that hyoid movement can be tracked automatically, providing measurable continuous positional data. Measurements derived from this objective data are comparable with similar measures previously reported using videofluoroscopy and of the two automatic trackers assessed, the DNN approach demonstrates better robustness and higher agreement with manually derived measures. Using this kinematic data, hyoid movement can be related to different stages of swallowing. Clinical implications of this study This study contributes towards our understanding of the kinematics of a typical swallow by evaluating an automated hyoid tracking method, paving the way for future studies of typical and disordered swallow. The challenges of image acquisition highlight issues to be considered when establishing clinical protocols. The application of machine learning enhances the utility of ultrasound swallowing assessment by reducing the labour required and permitting a wider range of hyoid measurements. Further research in normative and clinical populations is facilitated by automatic data extraction allowing the validity of prospective hyoid measures in differentiating different types of swallows to be rigorously assessed.
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Affiliation(s)
- Joan K.‐Y. Ma
- Clinical Audiology, Speech and Language Research CentreQueen Margaret UniversityEdinburghUK
| | - Alan A. Wrench
- Clinical Audiology, Speech and Language Research CentreQueen Margaret UniversityEdinburghUK
- Articulate Instruments LtdEdinburgh, EH21 6UUUK
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Winiker K, Hammond R, Thomas P, Dimmock A, Huckabee M. Swallowing assessment in patients with dysphagia: Validity and reliability of a pocket-sized ultrasound system. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:539-551. [PMID: 35112768 PMCID: PMC9305130 DOI: 10.1111/1460-6984.12703] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/11/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The use of ultrasound as an adjunct to clinical swallowing evaluation provides quantitative physiological and morphological data. As a low-risk procedure, ultrasound imaging can be performed outside of a medical setting. This is particularly important for patients living in rural areas with restricted access to a hospital. Technical advances have produced pocket-sized ultrasound technology that is more affordable, and therefore within the fiscal reach of most allied health services. AIMS To explore the validity and reliability of pocket-sized ultrasound technology in dysphagia assessment. METHODS & PROCEDURES Data were acquired from 43 patients with dysphagia using the Clarius ultrasound device. Ultrasound and videofluoroscopic measures of hyoid and laryngeal displacement during liquid and puree swallowing were collected concurrently to quantify correlation and agreement between identical measures derived from the two instruments. Reliability of ultrasound was assessed for measures of hyoid and laryngeal displacement, tongue thickness, and size of the submental muscles in eight patients. Reliability was evaluated for the entire process of data acquisition including scanning and online measurement using an iPad in a clinical setting and for offline measurement on a computer screen to explore environmental influences on reliability. OUTCOMES & RESULTS Results revealed poor correlation between the measures of interest across instruments. Reliability of the entire process of data acquisition in a clinical setting was insufficient while reliability was more promising for offline measurements. CONCLUSIONS & IMPLICATIONS The clinical use of pocket-sized ultrasound devices, such as the Clarius system, for swallowing evaluation is not indicated at this time. Enhanced validity and reliability of the entire process of data acquisition are needed prior to clinical translation of such technology. WHAT THIS PAPER ADDS What is already known on the subject The use of ultrasound allows for radiation-free, non-invasive swallowing assessment. Some data suggest that ultrasound is valid and reliable in the evaluation of swallowing using standard-sized equipment. Insufficient validity and reliability have been reported for pocket-sized ultrasound technology in the assessment of healthy swallowing. What this paper adds to existing knowledge This research is the first to provide validity and reliability data of the pocket-sized Clarius technology in the evaluation of swallowing in patients with dysphagia. Insufficient validity and reliability of online data acquisition in a clinical environment were found. Reliability for offline measurement was more promising. What are the potential or actual clinical implications of this work? The clinical use of pocket-sized ultrasound devices, such as the Clarius system, for swallowing assessment is not indicated at this time.
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Affiliation(s)
- Katharina Winiker
- Department of PsychologySpeech and Hearing, University of CanterburyChristchurchNew Zealand
- Rose Centre for Stroke Recovery and ResearchUniversity of CanterburyChristchurchNew Zealand
- Department of Research and DevelopmentSwiss University of Speech and Language Sciences SHLRRorschachSwitzerland
| | - Rebecca Hammond
- Department of PsychologySpeech and Hearing, University of CanterburyChristchurchNew Zealand
- Rose Centre for Stroke Recovery and ResearchUniversity of CanterburyChristchurchNew Zealand
- Speech‐Language TherapyWaitematā District Health BoardAucklandNew Zealand
| | - Paige Thomas
- Department of PsychologySpeech and Hearing, University of CanterburyChristchurchNew Zealand
- Rose Centre for Stroke Recovery and ResearchUniversity of CanterburyChristchurchNew Zealand
- Speech‐Language TherapyWaitematā District Health BoardAucklandNew Zealand
| | - Alice Dimmock
- Speech‐Language TherapyWaitematā District Health BoardAucklandNew Zealand
| | - Maggie‐Lee Huckabee
- Department of PsychologySpeech and Hearing, University of CanterburyChristchurchNew Zealand
- Rose Centre for Stroke Recovery and ResearchUniversity of CanterburyChristchurchNew Zealand
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18
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The kinematic features of hyoid bone movement during swallowing in different disease populations: A narrative review. J Formos Med Assoc 2022; 121:1892-1899. [DOI: 10.1016/j.jfma.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 04/06/2022] [Accepted: 04/10/2022] [Indexed: 11/21/2022] Open
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Swallowing kinematic analysis might be helpful in predicting aspiration and pyriform sinus stasis. Sci Rep 2022; 12:1354. [PMID: 35079109 PMCID: PMC8789786 DOI: 10.1038/s41598-022-05441-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/12/2022] [Indexed: 11/09/2022] Open
Abstract
Aspiration due to dysphagia can lead to aspiration, which negatively impacts a patient’s overall prognosis. Clinically, videofluoroscopic swallow study (VFSS) is considered the gold-standard instrument to determine physiological impairments of swallowing. According to previously published literature, kinematic analyses of VFSS might provide further information regarding aspiration detection. In this study, 449 files of VFSS studies from 232 patients were divided into three groups: normal, aspiration, and pyriform sinus stasis. Kinematic analyses and between-group comparison were conducted. Significant between-group differences were noted among parameters of anterior hyoid displacement, maximal hyoid displacement, and average velocity of hyoid movement. No significant difference was detected in superior hyoid displacement. Furthermore, receiver-operating characteristic (ROC) analyses of anterior hyoid displacement, velocity of anterior hyoid displacement, and average velocity of maximal hyoid displacement showed acceptable predictability for detecting aspiration. Using 33.0 mm/s as a cutoff value of average velocity of maximal hyoid displacement, the sensitivity of detecting the presence of aspiration was near 90%. The investigators therefore propose that the average velocity of maximal hyoid displacement may serve as a potential screening tool to detect aspiration.
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Martins GDS, Bandeira JDF, Alves MSGL, Costa BOID, Pernambuco L. Medidas cinemáticas da deglutição obtidas por ultrassonografia: um protocolo de revisão de escopo. REVISTA CEFAC 2022. [DOI: 10.1590/1982-0216/20222456922s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RESUMO Objetivo: identificar e sintetizar as evidências científicas sobre medidas cinemáticas da deglutição obtidas por ultrassonografia. Métodos: este protocolo seguiu a metodologia proposta pelo Joanna Briggs Institute (JBI) e as diretrizes para elaboração de revisões de escopo do Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols - extension for scoping reviews (PRISMA-ScR). As bases de dados eletrônicas pesquisadas serão: PubMed/Medline, Scopus, Web of Science, Lilacs, ScienceDirect, Embase e Google Scholar. Uma estratégia de busca foi desenvolvida para PubMed/Medline, que será adaptada para cada base de dados. Inicialmente, os artigos serão rastreados pelo título e resumo por dois revisores independentes. Em seguida, farão a leitura do texto completo dos artigos de acordo com os critérios de elegibilidade. Os dados serão extraídos dos artigos incluídos por meio de formulário padronizado. Os resultados serão apresentados em fluxograma e resumo narrativo. Considerações Finais: a execução deste protocolo apresentará o estado da arte sobre o tema pesquisado e contribuirá para a melhor compreensão das possibilidades de análise quantitativa da deglutição por meio da ultrassonografia.
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Allen JE, Clunie G, Ma JKY, Coffey M, Winiker K, Richmond S, Lowell SY, Volkmer A. Translating Ultrasound into Clinical Practice for the Assessment of Swallowing and Laryngeal Function: A Speech and Language Pathology-Led Consensus Study. Dysphagia 2022; 37:1586-1598. [PMID: 35201387 PMCID: PMC8867131 DOI: 10.1007/s00455-022-10413-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/19/2022] [Indexed: 12/16/2022]
Abstract
Ultrasound (US) has an emerging evidence base for the assessment of swallowing and laryngeal function. Accessibility and technological advances support the use of US as a clinical assessment tool; however, there is insufficient evidence to support its translation into clinical practice. This study aimed to establish consensus on the priorities for translation of US into clinical practice for the assessment of swallowing and laryngeal function. Nominal Group Technique (NGT) was used as a formal method of consensus development. Clinicians and academics, all members of an international US working group, were invited to participate in the study. Two NGT meetings were held, where participants silently generated and then shared ideas. Participants anonymously ranked items. Rankings were aggregated before participants re-ranked items in order of priority. Discussions regarding rankings were recorded and transcribed to inform analysis. Member-checking with participants informed the final analysis. Participants (n = 15) were speech and language pathologists, physiotherapists and sonographers representing six countries. Fifteen items were identified and prioritised 1-13 (including two equally ranked items). Reliability, validity and normative data emerged as key areas for research while development of training protocols and engagement with stakeholders were considered vital to progressing US into practice. Analysis revealed common themes that might be addressed together in research, in addition to the ranked priority. A measured approach to the translation of US into clinical practice will enable effective implementation of this tool. Priorities may evolve as clinical and professional contexts shift, but this study provides a framework to advance research and clinical practice in this field.
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Affiliation(s)
- Jodi E. Allen
- The National Hospital for Neurology and Neurosurgery, Therapy & Rehabilitation Services, 2nd Floor 8-11 Queen Square, London, WC1N 3BG UK
| | - Gemma Clunie
- SLT Department, Imperial College Healthcare Trust, Charing Cross Hospital, London, UK
| | - Joan K.-Y. Ma
- Clinical Audiology, Speech and Language Research Centre, Queen Margaret University, Edinburgh, UK
| | - Margaret Coffey
- SLT Department, Imperial College Healthcare Trust, Charing Cross Hospital, London, UK
| | - Katharina Winiker
- Swiss University of Speech and Language Sciences SHLR, Seminarstrasse 27, 9400 Rorschach, Switzerland
| | - Sally Richmond
- Imaging Department, University College London Hospitals, London, UK
| | - Soren Y. Lowell
- Communication Sciences & Disorders Department, Syracuse University, Syracuse, NY USA
| | - Anna Volkmer
- Division of Psychology and Language Sciences, University College London, London, UK
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22
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Martins GDS, Bandeira JDF, Alves MSGL, Costa BOID, Pernambuco L. Kinematic measures of swallowing obtained with ultrasound: a scoping review protocol. REVISTA CEFAC 2022. [DOI: 10.1590/1982-0216/20222456922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
ABSTRACT Purpose: to identify and synthesize scientific evidence on kinematic measures of swallowing obtained with ultrasound. Methods: a protocol following the methodology proposed by the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols - extension for scoping reviews (PRISMA-ScR). The search will be made in PubMed/MEDLINE, Scopus, Web of Science, LILACS, ScienceDirect, Embase, and Google Scholar, using a search strategy developed for PubMed/MEDLINE, which will be adapted for each database. Articles will be initially screened by title and abstract by two independent reviewers who will read their full text according to the eligibility criteria. Data in included articles will be extracted by means of a standardized form and the results presented in a flowchart and narrative summary. Final Considerations: once carried out, this protocol will present the state-of-the-art on the research topic and help better understand the possibilities to quantitatively analyze swallowing through ultrasound.
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Hsiao MY, Wu CH, Wang TG. Emerging Role of Ultrasound in Dysphagia Assessment and Intervention: A Narrative Review. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:708102. [PMID: 36188819 PMCID: PMC9397709 DOI: 10.3389/fresc.2021.708102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/14/2021] [Indexed: 11/13/2022]
Abstract
Ultrasonography has gained increasing attention as a non-invasive and radiation-free instrument for the assessment of swallowing function. In the past decades, an extensive repertoire of ultrasonographic techniques, such as, B-mode dynamic scanning, pixel analysis, M-mode, Doppler, 3D reconstruction, and sonoelastography, has been applied in the evaluation of oropharyngeal structures and movement. Yet, a universal consensus on the examination protocols and clinical implications remains to be established. This review aimed to provide a brief introduction of the application of ultrasound in dysphagia assessment and intervention, encompassing the ultrasonography of swallowing-related muscles, tongue movement, and hyolaryngeal excursion, as well as ultrasound-guided interventions in the management of dysphagia. In addition to non-invasiveness, ultrasonography, a portable, easy to use, and low-cost technique, could compliment videofluoroscopic swallowing study as a first-line screening and follow-up tool for the evaluation of swallowing function, although further study is warranted to provide quantitative diagnostic and prognostic values. Finally, ultrasonography aids in the precisely targeted injection of botulinum toxin in patients exhibiting oropharyngeal muscle spasticity.
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Affiliation(s)
- Ming-Yen Hsiao
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Chueh-Hung Wu
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-chu Branch, Hsinchu, Taiwan
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
- *Correspondence: Tyng-Guey Wang
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Winiker K, Burnip E, Gozdzikowska K, Hernandez EG, Hammond R, Macrae P, Thomas P, Huckabee ML. Ultrasound: Reliability of a Pocket-Sized System in the Assessment of Swallowing. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:2928-2940. [PMID: 34260263 DOI: 10.1044/2021_jslhr-21-00026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose Ultrasound imaging offers a noninvasive adjunct to clinical swallowing assessment. Published reliability of sophisticated ultrasound systems is promising; however, no data exist for reliability using more affordable, pocket-sized devices. This study explored intrarater, interrater, and test-retest reliability of swallowing measures acquired with pocket-sized ultrasound technology. Method Five participants collected measures of swallowing from 20 healthy individuals using the Clarius ultrasound. Hyoid excursion and thyrohyoid approximation were derived during saliva, liquid, and puree swallowing. The cross-sectional area of the floor of mouth muscles and tongue thickness were obtained at rest. Measures were collected at two occasions minimum 11 days apart. Reliability was assessed for the entire process of data acquisition including scanning and online measurement, and for offline measurement of saved images. Results For most measures, reliability was poor (ICC [intraclass correlation coefficient] < .50) to moderate (ICC = .50-.75) for the entire process of data acquisition and poor to good (ICC > .75) when measuring saved images. Conclusion Further work is needed to elucidate whether our study findings apply to the Clarius system only or the data suggest a general limitation of pocket-sized ultrasound technology.
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Affiliation(s)
- Katharina Winiker
- Department of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
- University of Canterbury Rose Centre for Stroke Recovery and Research, Christchurch, New Zealand
- Swiss University of Speech and Language Sciences, Rorschach, Switzerland
| | - Emma Burnip
- Department of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
- University of Canterbury Rose Centre for Stroke Recovery and Research, Christchurch, New Zealand
| | - Kristin Gozdzikowska
- Department of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
- University of Canterbury Rose Centre for Stroke Recovery and Research, Christchurch, New Zealand
- Research and Innovation, University of Canterbury, Christchurch, New Zealand
| | - Esther Guiu Hernandez
- Department of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
- University of Canterbury Rose Centre for Stroke Recovery and Research, Christchurch, New Zealand
| | - Rebecca Hammond
- Department of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
- University of Canterbury Rose Centre for Stroke Recovery and Research, Christchurch, New Zealand
- Waitematā District Health Board, Auckland, New Zealand
| | - Phoebe Macrae
- Department of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
- University of Canterbury Rose Centre for Stroke Recovery and Research, Christchurch, New Zealand
| | - Paige Thomas
- Department of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
- University of Canterbury Rose Centre for Stroke Recovery and Research, Christchurch, New Zealand
| | - Maggie-Lee Huckabee
- Department of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
- University of Canterbury Rose Centre for Stroke Recovery and Research, Christchurch, New Zealand
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Allen JE, Clunie GM, Winiker K. Ultrasound: an emerging modality for the dysphagia assessment toolkit? Curr Opin Otolaryngol Head Neck Surg 2021; 29:213-218. [PMID: 33741822 PMCID: PMC7611059 DOI: 10.1097/moo.0000000000000708] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE OF REVIEW Videofluoroscopy (VFSS) and fibreoptic endoscopic evaluation of swallowing (FEES) are established instrumental techniques to support differential diagnosis and treatment of oropharyngeal dysphagia. Whilst their value is undisputed, each tool is not without limitations. The COVID-19 pandemic has restricted access to VFSS and FEES leading clinicians to explore alternative or augmentative tools to support swallowing assessment.Ultrasound (US) is an established tool for visualisation of head and neck anatomy, including structures implicated in swallowing. Although US has been utilised in swallowing research for many years, its application has not translated into common clinical practice. This review presents and debates the evidence for and against use of US for clinical swallowing assessment. RECENT FINDINGS Evaluation of swallowing muscle morphometry and measurement of isolated swallowing kinematics are two primary uses of US in swallowing assessment that have been identified in the literature. Use of US to detect bolus flow, aspiration and residues is in its early stages and needs further research. SUMMARY US shows promise as an adjunctive modality to support assessment of swallowing. With standardisation, these measurements may have potential for transition into clinical care. Reliability and validity testing and development of normative data are imperative to ensure its use as an evidence-based instrumentation.
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Affiliation(s)
- Jodi E Allen
- University College London Hospitals NHS Foundation Trust, National Hospital for Neurology & Neurosurgery
| | - Gemma M Clunie
- National Centre for Airway Reconstruction, Department of Otolaryngology, Head and Neck Surgery, Imperial College Healthcare NHS Trust
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Katharina Winiker
- Swiss University of Speech and Language Sciences SHLR, Rorschach, Switzerland
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Winiker K, Burnip E, Gozdzikowska K, Guiu Hernandez E, Hammond R, Macrae P, Huckabee ML. Ultrasound: Validity of a Pocket-Sized System in the Assessment of Swallowing. Dysphagia 2021; 36:1010-1018. [PMID: 33389177 PMCID: PMC7778487 DOI: 10.1007/s00455-020-10232-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 12/10/2020] [Indexed: 11/28/2022]
Abstract
Adequate hyoid and laryngeal displacement facilitate safe and efficient swallowing. Although videofluoroscopy is commonly used for assessment of this biomechanical event, ultrasound provides benefits as a radiation-free modality for this purpose. This study investigated validity of a pocket-sized ultrasound system (Clarius™) in the assessment of hyoid and laryngeal excursion. Hyoid excursion and thyrohyoid approximation were concurrently assessed in 20 healthy adults using ultrasound and videofluoroscopy during saliva, liquid, and puree swallowing. Correlation analyses were performed to evaluate validity. There was a strong and moderate positive association between ultrasound and videofluoroscopic measurements of hyoid excursion during dry and liquid swallowing, respectively. No evidence for a significant association was found for ultrasound and videofluoroscopic measurements of hyoid excursion for puree swallowing and of thyrohyoid approximation for any bolus type. Further work towards improved validity is necessary prior to clinical transfer of the pocket-sized Clarius™ system in clinical swallowing assessment.
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Affiliation(s)
- Katharina Winiker
- Department of Psychology, Speech and Hearing, University of Canterbury, Private Bag 4800, Christchurch, 8140, New Zealand. .,The University of Canterbury Rose Centre for Stroke Recovery and Research, 249 Papanui Rd, Private Bag 4737, Christchurch, 8140, New Zealand. .,Swiss University of Speech and Language Sciences SHLR, Seminarstrasse 27, 9400, Rorschach, Switzerland.
| | - Emma Burnip
- Department of Psychology, Speech and Hearing, University of Canterbury, Private Bag 4800, Christchurch, 8140, New Zealand.,The University of Canterbury Rose Centre for Stroke Recovery and Research, 249 Papanui Rd, Private Bag 4737, Christchurch, 8140, New Zealand
| | - Kristin Gozdzikowska
- Department of Psychology, Speech and Hearing, University of Canterbury, Private Bag 4800, Christchurch, 8140, New Zealand.,The University of Canterbury Rose Centre for Stroke Recovery and Research, 249 Papanui Rd, Private Bag 4737, Christchurch, 8140, New Zealand.,The Laura Fergusson Trust, 279 Ilam Road, Christchurch, 8053, New Zealand
| | - Esther Guiu Hernandez
- Department of Psychology, Speech and Hearing, University of Canterbury, Private Bag 4800, Christchurch, 8140, New Zealand.,The University of Canterbury Rose Centre for Stroke Recovery and Research, 249 Papanui Rd, Private Bag 4737, Christchurch, 8140, New Zealand
| | - Rebecca Hammond
- Department of Psychology, Speech and Hearing, University of Canterbury, Private Bag 4800, Christchurch, 8140, New Zealand.,The University of Canterbury Rose Centre for Stroke Recovery and Research, 249 Papanui Rd, Private Bag 4737, Christchurch, 8140, New Zealand.,Waitematā District Health Board, Private Bag 93 503, Auckland, 0622, New Zealand
| | - Phoebe Macrae
- Department of Psychology, Speech and Hearing, University of Canterbury, Private Bag 4800, Christchurch, 8140, New Zealand.,The University of Canterbury Rose Centre for Stroke Recovery and Research, 249 Papanui Rd, Private Bag 4737, Christchurch, 8140, New Zealand
| | - Maggie-Lee Huckabee
- Department of Psychology, Speech and Hearing, University of Canterbury, Private Bag 4800, Christchurch, 8140, New Zealand.,The University of Canterbury Rose Centre for Stroke Recovery and Research, 249 Papanui Rd, Private Bag 4737, Christchurch, 8140, New Zealand
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Lai CJ, Chen JS, Ho SI, Lu ZY, Huang YJ, Cheng YJ. Detecting Oropharyngeal and Esophageal Emptying by Submental Ultrasonography and High-Resolution Impedance Manometry: Intubated vs. Non-Intubated Video-Assisted Thoracoscopic Surgery. Diagnostics (Basel) 2020; 10:diagnostics10121079. [PMID: 33322685 PMCID: PMC7763338 DOI: 10.3390/diagnostics10121079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/04/2020] [Accepted: 12/09/2020] [Indexed: 12/04/2022] Open
Abstract
Postoperative swallowing, affected by general anesthesia and intubation, plays an important part in airway and oral intake safety regarding effective oropharyngeal and esophageal emptying. However, objective evidence is limited. This study aimed to determine the time required from emergence to effective oropharyngeal and esophageal emptying in patients undergoing non-intubated (N) or tracheal-intubated (I) video-assisted thoracoscopic surgery (VATS). Hyoid bone displacement (HBD) by submental ultrasonography and high-resolution impedance manometry (HRIM) measurements were used to assess oropharyngeal and esophageal emptying. HRIM was performed every 10 min after emergence, up to 10 times. The primary outcome was to determine whether intubation affects the time required from effective oropharyngeal to esophageal emptying. The secondary outcome was to verify if HBD is comparable to preoperative data indicating effective oropharyngeal emptying. Thirty-two patients suitable for non-intubated VATS were recruited. Our results showed that comparable HBDs were achieved in all patients after emergence. Effective esophageal emptying was achieved at the first HRIM measurement in 11 N group patients and 2 I group patients (p = 0.002) and was achieved in all N (100%) and 13 I group patients (81%) within 100 min (p = 0.23). HBD and HRIM are warranted for detecting postoperative oropharyngeal and esophageal emptying.
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Affiliation(s)
- Chih-Jun Lai
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei 100025, Taiwan;
- Department of Anesthesiology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 100225, Taiwan; (S.-IH.); (Z.-Y.L.); (Y.-J.H.)
| | - Jin-Shing Chen
- Department of Surgery, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei 106037, Taiwan;
| | - Shih-I Ho
- Department of Anesthesiology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 100225, Taiwan; (S.-IH.); (Z.-Y.L.); (Y.-J.H.)
| | - Zhi-Yin Lu
- Department of Anesthesiology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 100225, Taiwan; (S.-IH.); (Z.-Y.L.); (Y.-J.H.)
| | - Yi-Ju Huang
- Department of Anesthesiology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 100225, Taiwan; (S.-IH.); (Z.-Y.L.); (Y.-J.H.)
| | - Ya-Jung Cheng
- Department of Anesthesiology, College of Medicine, National Taiwan University, Taipei 100233, Taiwan
- Department of Anesthesiology, National Taiwan University Cancer Center, Taipei 106037, Taiwan
- Correspondence: ; Tel.: +886-2-2312-3456 (ext. 65517)
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28
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Chen YC, Chen PY, Wang YC, Wang TG, Han DS. Decreased swallowing function in the sarcopenic elderly without clinical dysphagia: a cross-sectional study. BMC Geriatr 2020; 20:419. [PMID: 33087067 PMCID: PMC7579958 DOI: 10.1186/s12877-020-01832-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 10/13/2020] [Indexed: 11/17/2022] Open
Abstract
Background Sarcopenia and dysphagia are prevalent health issues as the elderly population continues to grow. However, whether sarcopenia, defined by either reduced handgrip strength or gait speed, would lead to pathological effects on swallowing function is still a matter of debate. Studies focusing on subclinical changes in the swallowing function in the sarcopenic elderly are lacking. This study evaluates the swallowing function in the sarcopenic elderly without dysphagia. Methods: A cross-sectional study was conducted including subjects recruited from the community. Ninety-four individuals aged 65 and older without dysphagia were divided into two groups: sarcopenia and nonsarcopenia. The swallowing assessment included tongue pressure measurement, hyoid displacement (HD), hyoid velocity (HV) measurement with submental ultrasonography, 100-ml water-swallowing test, and the 10-item Eating Assessment Tool (EAT-10). Results The average tongue pressure was 47.0 ± 13.7 and 48.6 ± 11.5 kPa in the sarcopenia and nonsarcopenia groups, respectively (p = 0.55), whereas the average HD during swallowing was 15.3 ± 4.4 and 13.0 ± 4.2 mm in the sarcopenia and nonsarcopenia groups, respectively (p < 0.05). The median of HV during swallowing was 19.5 (6.41–45.86) and 15.9 (3.7–39.7) mm/s in the sarcopenia and nonsarcopenia group (p < 0.05). The median of time needed for consuming 100 ml water was 12.43 (3.56–49.34) and 5.66 (2.07–19.13) seconds in the sarcopenia and nonsarcopenia groups, respectively (p < 0.05). The median of the EAT-10 score was 0 (0–2) and 0 (0–1) in the sarcopenia and nonsarcopenia groups, respectively (p < 0.05). Conclusions In elderly individuals, swallowing function was significantly impaired with sarcopenia before clinical symptoms become clear. However, tongue muscles exhibited resistance to sarcopenia. We observed compensative strategies in patients with sarcopenia, such as reduced swallowing speed and increased hyoid bone movement.
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Affiliation(s)
- Yen-Chih Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, No.1, Changde Street, Zhongzheng District, Taipei City, 10048, Taiwan, Republic of China
| | - Pei-Yun Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, No.1, Changde Street, Zhongzheng District, Taipei City, 10048, Taiwan, Republic of China
| | - Yu-Chen Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, No.1, Changde Street, Zhongzheng District, Taipei City, 10048, Taiwan, Republic of China
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, No.1, Changde Street, Zhongzheng District, Taipei City, 10048, Taiwan, Republic of China.
| | - Der-Sheng Han
- Physical Medicine & Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, No.87, Neijiang Street, Wanhua District, Taipei City, Taiwan
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29
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Costa BOID, Rodrigues DDSB, Magalhães DDDD, Santos AS, Santos RV, Azevedo EHM, Almeida AA, Pernambuco L. Quantitative Ultrasound Assessment of Hyoid Bone Displacement During Swallowing Following Thyroidectomy. Dysphagia 2020; 36:659-669. [PMID: 32889628 DOI: 10.1007/s00455-020-10180-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/24/2020] [Indexed: 02/07/2023]
Abstract
The aim of this study was to investigate temporal ultrasound measurements of the hyoid bone displacement during swallowing following thyroidectomy in women and to relate these measures to age, clinical outcomes, and upper digestive airway symptoms. The sample was divided into an experimental group (EG) of 20 women who underwent thyroidectomy (mean age = 49.55 years ± 15.14) and a control group (CG) of 20 healthy women volunteers (mean age = 40.75 years ± 15.92). Both groups were submitted to ultrasound assessment to obtain four temporal measurements of hyoid bone displacement during swallowing: elevation, anteriorization, maximum displacement, and maintenance of maximum displacement. In both groups, swallowing of ten milliliters of liquid and the same volume of thickened liquid (honey) were analyzed. The images were recorded on video (30 frames/second) and analyzed according to a standardized protocol. Temporal measurements of hyoid bone elevation and maximum displacement during swallowing of thickened liquid were significantly shorter in EG (p = 0.034 and p = 0.020, respectively). There were no differences in the swallowing of liquid, and no other variable was related to the ultrasound temporal measurements investigated. This study concludes that women who undergo thyroidectomy have a shorter time of hyoid bone elevation and maximum displacement during swallowing of 10 mL of thickened liquid.
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Affiliation(s)
- Bianca Oliveira Ismael da Costa
- Graduate Program in Speech, Language and Hearing Sciences (PPgFon/UFPB-UFRN-UNCISAL), Universidade Federal da Paraíba (UFPB), Campus I s/n, Cidade Universitária, João Pessoa, PB, 58051-900, Brazil
| | - Darlyane de Souza Barros Rodrigues
- Graduate Program in Speech, Language and Hearing Sciences (PPgFon/UFPB-UFRN-UNCISAL), Universidade Federal da Paraíba (UFPB), Campus I s/n, Cidade Universitária, João Pessoa, PB, 58051-900, Brazil
| | - Desiré Dominique Diniz de Magalhães
- Graduate Program in Speech, Language and Hearing Sciences (PPgFon/UFPB-UFRN-UNCISAL), Universidade Federal da Paraíba (UFPB), Campus I s/n, Cidade Universitária, João Pessoa, PB, 58051-900, Brazil
| | - Ary Serrano Santos
- Lauro Wanderley University Hospital (HULW/UFPB/EBSERH), Universidade Federal da Paraíba (UFPB), R. Tabelião Stanislau Eloy, 585, Castelo Branco, João Pessoa, PB, 58050-585, Brazil
| | - Ricardo Vieira Santos
- Lauro Wanderley University Hospital (HULW/UFPB/EBSERH), Universidade Federal da Paraíba (UFPB), R. Tabelião Stanislau Eloy, 585, Castelo Branco, João Pessoa, PB, 58050-585, Brazil
| | - Elma Heitmann Mares Azevedo
- Department of Speech, Language and Hearing Sciences, Universidade Federal do Espírito Santo (UFES), Av. Marechal Campos, 1468, Maruípe, Vitória, ES, 29043-900, Brazil
| | - Anna Alice Almeida
- Graduate Program in Speech, Language and Hearing Sciences (PPgFon/UFPB-UFRN-UNCISAL), Universidade Federal da Paraíba (UFPB), Campus I s/n, Cidade Universitária, João Pessoa, PB, 58051-900, Brazil.,Department of Speech, Language and Hearing Sciences, Universidade Federal da Paraíba (UFPB), Campus I s/n, Cidade Universitária, João Pessoa, PB, 58051-900, Brazil
| | - Leandro Pernambuco
- Graduate Program in Speech, Language and Hearing Sciences (PPgFon/UFPB-UFRN-UNCISAL), Universidade Federal da Paraíba (UFPB), Campus I s/n, Cidade Universitária, João Pessoa, PB, 58051-900, Brazil. .,Department of Speech, Language and Hearing Sciences, Universidade Federal da Paraíba (UFPB), Campus I s/n, Cidade Universitária, João Pessoa, PB, 58051-900, Brazil.
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Picelli A, Modenese A, Poletto E, Businaro V, Varalta V, Gandolfi M, Bonetti B, Smania N. May ultrasonography be considered a useful tool for bedside screening of dysphagia in patients with acute stroke? A cohort study. Minerva Med 2020; 112:354-358. [PMID: 32338483 DOI: 10.23736/s0026-4806.20.06571-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Dysphagia is a primary risk factor for pneumonia and affects around 50% of acute stroke patients. Systematic bedside swallowing screening of acute stroke patients is recommended before oral intake. Currently there is lack of comprehensive dysphagia assessment tools with robust good accuracy, clinical utility and cost-effectiveness. An altered hyoid bone movement may represent a major risk factor for aspiration. Ultrasonography quantitatively measures hyoid-larynx approximation, which was found reduced in stroke patients with dysphagia. Although ultrasonography was suggested for assessing stroke patients with dysphagia, there is lack of evidence about the acute phase of stroke. Thus, our aim was to investigate the use of ultrasonography for bedside screening of dysphagia in acute stroke patients. METHODS Nineteen acute stroke patients were included. Each patient performed clinical bedside screening for dysphagia by means of the Gugging Swallow Screen and the Functional Oral Intake Scale. Furthermore, all patients underwent ultrasonography in order to measure the distance between the thyroid cartilage and hyoid bone during swallowing (water bolus of 3 mL). The hyoid-larynx approximation distance (obtained by subtracting [a-b] the shortest distance between the hyoid bone and thyroid cartilage during swallowing (b) from the initial resting distance (a) and degree {[(a-b)/a]×100} were calculated). RESULTS The Functional Oral Intake Scale showed a significant direct association with the hyoid-larynx approximation distance (P=0.011) and degree (P=0.005). Also, the Gugging Swallow Screen showed a significant direct association with the hyoid-larynx approximation distance (P=0.008) and degree (P=0.004). The hyoid-larynx approximation distance and degree were significantly reduced in dysphagic patients. CONCLUSIONS Our findings support the use of ultrasonography in aid of swallowing clinical (non-instrumental) evaluation for the bedside screening of dysphagia in acute stroke patients.
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Affiliation(s)
- Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Physical and Rehabilitation Medicine, Neuromotor and Cognitive Rehabilitation Research Center, University of Verona, Verona, Italy - .,Unit of Neurorehabilitation, Department of Neurosciences, University Hospital of Verona, Verona, Italy -
| | - Angela Modenese
- Unit of Neurorehabilitation, Department of Neurosciences, University Hospital of Verona, Verona, Italy
| | - Elena Poletto
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Physical and Rehabilitation Medicine, Neuromotor and Cognitive Rehabilitation Research Center, University of Verona, Verona, Italy
| | - Valentina Businaro
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Physical and Rehabilitation Medicine, Neuromotor and Cognitive Rehabilitation Research Center, University of Verona, Verona, Italy
| | - Valentina Varalta
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Physical and Rehabilitation Medicine, Neuromotor and Cognitive Rehabilitation Research Center, University of Verona, Verona, Italy
| | - Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Physical and Rehabilitation Medicine, Neuromotor and Cognitive Rehabilitation Research Center, University of Verona, Verona, Italy.,Unit of Neurorehabilitation, Department of Neurosciences, University Hospital of Verona, Verona, Italy
| | - Bruno Bonetti
- Stroke Unit, Department of Neurosciences, University Hospital of Verona, Verona, Italy
| | - Nicola Smania
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Physical and Rehabilitation Medicine, Neuromotor and Cognitive Rehabilitation Research Center, University of Verona, Verona, Italy.,Unit of Neurorehabilitation, Department of Neurosciences, University Hospital of Verona, Verona, Italy
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31
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Evaluation of swallowing movement using ultrasonography. Radiol Phys Technol 2019; 13:62-68. [PMID: 31786806 DOI: 10.1007/s12194-019-00547-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 11/20/2019] [Accepted: 11/26/2019] [Indexed: 10/25/2022]
Abstract
The aim of this study is to develop an index to assess swallowing function by ultrasonography to evaluate the relationship between movements of the hyoid bone and the larynx while swallowing water. Forty-two younger participants (mean age, 20.3 ± 3.4 years) and 42 older participants (mean age, 75.1 ± 10.6 years) with normal swallowing function were included in the study. Movements of the hyoid bone and the larynx while swallowing 5 mL of water were observed using ultrasonography. Two-dimensional distances from the starting points of the hyoid bone and the larynx to their points of maximum movement were measured as displacements. The hyoid bone-laryngeal motion ratio was defined as the hyoid bone displacement divided by the laryngeal displacement. Parameters were compared among four groups: younger male, younger female, older male, and older female. The hyoid bone displacement differed significantly between the younger and older groups, and the laryngeal displacement differed significantly between age groups and sexes. The hyoid bone-laryngeal motion ratio was not significantly correlated with age, height, or body weight, and did not show a significant difference between the four groups. Thus, the hyoid bone-laryngeal motion ratio is an index that evaluates swallowing movement and is independent of physique and physiological changes associated with aging.
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Kwak HJ, Kim L, Ryu BJ, Kim YH, Park SW, Cho DG, Lee CJ, Ha KW. Influence of Nasogastric Tubes on Swallowing in Stroke Patients: Measuring Hyoid Bone Movement With Ultrasonography. Ann Rehabil Med 2018; 42:551-559. [PMID: 30180524 PMCID: PMC6129699 DOI: 10.5535/arm.2018.42.4.551] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 10/20/2017] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the influence of a nasogastric tube (NGT) on swallowing simulated saliva in stroke patients. METHODS Three groups of participants were enrolled into the study: group A (20 stroke patients with a NGT), a control group B (25 stroke patients without a NGT), and group C (25 healthy adults with no brain lesions or dysphagia). Participants swallowed 1 mL of water to simulate saliva. Patients in group A were tested twice: once with a NGT (group A1) and once after the NGT was removed (group A2). The distance of hyoid bone movement was measured by subtracting the shortest distance between the mandible and hyoid bone (S) from the distance at resting state (R) measured with ultrasonography. The degree of the movement was calculated by (R-S)/R. The trajectory area of hyoid bone movement (Area) and the interval between the beginning of hyoid bone movement and the moment of the shortest hyoid-mandible approximation (Interval) was calculated by a computer program. RESULTS From group A: R-S and (R-S)/R of group A2 at 1.14±0.36 cm and 0.30±0.09 cm and were significantly greater than those of group A1 at 0.81±0.36 cm and 0.22±0.08 cm (p=0.009 and p=0.005). After removing the NGT as seen in group A2, R-S and (R-S)/R were improved to the level of those of group B at 1.20±0.32 cm and 0.30±0.09 cm (p=0.909 and p=0.997). The Area of group A2 was larger and the Interval of group A2 was shorter than those of group A1 though a comparison of these factors between A2 and A1 did not show a statistically significant difference. CONCLUSION A NGT interferes with the movement of the hyoid bone when swallowing 1 mL of water in stroke patients though the movement is restored to normal after removing the NGT.
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Affiliation(s)
- Ho-Jun Kwak
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul, Korea
| | - Lina Kim
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul, Korea
| | - Byung-Ju Ryu
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul, Korea
| | - Yun-Hee Kim
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul, Korea
| | - Seung-Wan Park
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul, Korea
| | - Dong-Gyu Cho
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul, Korea
| | - Cheol-Jae Lee
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul, Korea
| | - Kang-Wook Ha
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul, Korea
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